Telemedicine: The possibilities, practicalities and pitfalls

The internet has woven itself into the fabric of society, by offering a plethora of services which have evolved from luxuries to necessities.

Telemedicine – the use of the internet to transmit information for diagnosis and management – has garnered recent attention because of the Federal Government’s promise to provide AU$392million for its development, and the proposed national broadband network which may increase the efficiency of telemedical services. [1,2] Telemedicine, endorsed by the Australian Medical Association, [3] has a number of applications; however, the most highly publicised of these is the concept of online interactive consultations with a specialist practitioner in real-time, potentially using a Skype™-like platform.

In the coming years, telemedicine will likely play a significant role in our careers and as such, we must have an understanding of both its benefits and limitations. Despite the obvious potential of telemedicine, several questions remain in the minds of the public, doctors and also medical students. The first is: do we really require telemedicine? The costs are significant, but so is the need for the 12% of Australia’s population inhabiting outer regional and remote locales – data travels significantly faster over hundreds of kilometres than patients and their families. For example, geriatric patients even in the relatively large Queensland town of Rockhampton may need to travel over 600 kilometres to their nearest geriatrician. [4] For frail elderly patients, this is hardly practical. To help address this, the University of Queensland’s Centre for Online Health currently provides approximately 2,200 inpatient and outpatient consultations annually, primarily for geriatric and paediatric patients. A designated outpatient clinic exists at the Royal Children’s Hospital, Brisbane, and the transmission of video, radiological images, laboratory data and medical records allow distant consultants to conduct ‘video ward rounds’ for their inpatients. [4,5]

Nonetheless, even if there is a need for telemedicine, is it effective? Can doctors really diagnose and treat patients they are not in the physical presence of? Although telemedicine has been studied in several ways, two particular studies investigated these questions. A Canadian randomised controlled trial found that telepsychiatry and face-to-face psychiatry produced equivalent clinical outcomes [n = 495]. Further, when comparing the travel and accommodation costs of patients versus the cost of videoconferencing technology, the authors found the costs of the latter to be 10% cheaper. [6] Similarly, a Scottish study which compared 44 outpatient diagnoses and management plans made by a neurologist in a face-to-face…